ThedaCare, Rural Hospitals, EMTs Work Together to Quickly Care for Cardiac Patents
Ten years after Appleton and Neenah hospital physicians with ThedaCare created a standard protocol to quickly identify and treat heart attack patients, Code STEMI continues to make a difference in patients’ lives throughout the region.
As part of Code STEMI – which stands for Code ST-segment Elevation Myocardial Infarction, also known for the worst kind of heart attack – medical staff at a hospital or with an emergency medical service provider perform an EKG on a patient suspected of having a heart attack. The care provider can identify the STEMI heart attack and recommend angioplasty, which unblocks a clogged coronary artery, by looking at the EKG – even before the patient arrives at the hospital so plans can be made for surgery as quickly as possible.
While Code STEMI is used by medical facilities across the country, each one develops its own procedures and protocols. Regional team members from ThedaCare used creative and innovative thinking on how to rapidly expedite STEMI patients through the system. The result led to continued door to balloon times (angioplasty) well below national standards to open the blocked artery, said Julie Ludwig, Code STEMI manager for ThedaCare.
“Code STEMI is all about helping patients as quickly as possible so we can preserve heart muscle,” she said. “We work with all EMS services in the 14 counties served by ThedaCare hospitals to help them identify the signs of a possible heart attack and then how to get patients to the Appleton and Neenah cath labs as quickly as possible.”
For Appleton Medical Center patients, the average time from door to balloon insertion is 48 minutes, well below the national standard of 90 minutes. For patients at an outlying remote facility, who are brought to the hospital by EMS service and transported to Appleton Medical Center via ThedaStar, the average time from door to balloon is 98 minutes. The national guidelines call for 120 minutes.
Brian Guttormsen, MD, medical director for interventional cardiology and the Appleton Medical Center Chest Pain Center, said rural hospitals and EMTs play a key role in Code STEMI’s success. “We rely on them to make the diagnosis and triage the patients appropriately. They are the gatekeepers and help facilitate the right patient meeting the right doctor at the right time,” he said. “I cannot emphasize how important that is to providing high-quality patient care.”
Appleton Medical Center emergency room physician Greg Hunter, MD, said collaboration is vital in Code STEMI. “There’s a lot of communication that goes on between the field, the emergency department and the cardiologists,” said Dr. Hunter, who helped design AMC’s initial protocol with cardiologist Peter Ackell, MD. “We are all working together to cut out time in the process and delivering life-saving care to patients.”
Joy Hillstrom is one of those patients. An avid runner who completed 27 marathons, she was running on the treadmill one day when she began having chest pains. Hillstrom got to Appleton Medical Center and was quickly routed to the cath lab. “It all happened so fast. I’ve never gotten in to see a doctor so fast in my life,” said Hillstrom, who had a quintuple bypass and is back to running again.
Dr. Ackell said everyone involved with Code STEMI is focused on doing what’s best for the patient. “Not one specialized group owns the process alone,” he said. “We have established a relationship with all our system partners, who take care of acute cardiac patients. They have confidence that patients who may not meet STEMI criteria can still get rapid referral and care as appropriate. Communication has improved and will continue to get better.”
Through the years, medical staff members have tweaked Code STEMI to improve the process, Dr. Guttormsen said. “We have a standardized system-wide protocol across the Fox Valley, involving the pre-hospital care providers in the diagnosis and treatment of these patients and continued feedback and education regarding the care of these patients,” he said.
One example of cutting out time is blocking off an elevator once a Code STEMI is on the way to the hospital. “That way as soon as they arrive, the patient can get up to the cath lab. You don’t have to stand around waiting for that elevator to come,” Dr. Hunter said. “It’s just a few moments, but by making several changes like that, the time really adds up.”
with EMT services and emergency departments at other hospitals are vital to Code STEMI’s success, Ludwig said. During case reviews, she meets with EMS and hospital staff members to share patients’ stories. “The outreach is gratifying. It’s great to talk about how we’re working together to take care of these patients,” Ludwig said.
Code STEMI provides rural hospitals with fast access to cath labs at Appleton Medical Center and Theda Clark Medical Center, Dr. Ackell said. “I like to feel like we give these hospitals the ability to provide in each local community the state of the art when it comes to managing cardiac events,” he said. “Our rural hospital partners are the key feature of our program.”
For more than 100 years, ThedaCare™ has been committed to finding a better way to deliver serious and complex healthcare to patients throughout Northeast Wisconsin. The organization serves over 200,000 patients annually and employs more than 6,800 healthcare professionals throughout the region. ThedaCare has seven hospitals located in Appleton, Neenah, Berlin, Waupaca, Shawano, New London and Wild Rose as well as 34 clinics in 14 counties. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving our specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a non-profit healthcare organization with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs as well as a foundation dedicated to community service. The ThedaCare Regional Cancer Center in Appleton opened in February. For more information, visit www.thedacare.org or follow ThedaCare on Facebook and Twitter.